Depression,Doctors and Diet!

I've been running on and off for a number of years and have done 12 marathons to date. I'm currently training for another marathon in May, however I have problems, namely that I suffer from Chronic Depression. My medication is venlafaxine and olanzapine which is used to keep my depression under control and ensure that I sleep properly. One of the side effects of olanzapine is increased appetite and weight gain -I 'm currently 6'2" and 18 stone! I can currently run at 9 minute miling and run 20 miles per week but I would love to find some way of getting the weight off or losing the appetite. My doctor is very reluctant to change my medication as it is working well at keeping my depression under control. Is there a slim (pardon the pun) chance that someone else in forum land has had the same problem? or any doctors out there that can help? any good appetite supressants? I was very reluctant to post this but my weight is starting to get me down and I don't want it to pull me back into depression.....

Bill - sorry to hear you're struggling with this at the moment, I don't have any experience with medication for depression but the only advice i could offer would maybe looking at what you eat and when which may help? Having no experience of the effects of drugs i don't know if it would make any difference but i do know that the types of food you eat effect how you feel, white products (bread/pasta/etc etc) tend to make me hungry whereas things like protein and slow release carbs don't, i tend to avoid carbs like bread, potatoes and pasta and eat things like oats, nuts, veg, fish, white and red meats, I also eat 5 times a day with my main munch at lunch. Don't get me wrong, i'll quite happily tuck into a bag of crisps and a chocolate orange over crimbo but i'll avoid it normally and avoid sugar as if i it eat, i crave it, if i avoid it i don't want it and i feel less hungry, even eating natural sugars.

The caveman diet is a good pointer but there are some websites that are quite extreme and you don't want to go crazy with it, its just about avoiding refined sugar, white carbs and generally eating healthily.

Are you gaining weight? Are you simply expecting to put on weight having been given that prescription? What weight would you normally be? When was your last marathon?

I would not expect your GP to allow your weight to increase markedly because your prescription was successful at treating your depression. A referral to a dietitian would be appropriate.

Something is missing from your jigsaw.

Perhaps you think you are already overweight. Perhaps you wish to lose weight (without doing the extra running miles) so you are incorrectly attributing your weight to your prescription. Whatever you are thinking go back to your GP and ask to be referred to a dietitian, if you believe you are overweight or wish to control any potential weight gain.

If your depression is a relatively new feature and you feel it has contrived to affect your running I would suggest that you review the mileage that you were previously doing to have completed twelve marathons. It is unlikely to be 20 miles per week. If you are not able to step up your training mileage soon you may need to re-think your May marathon.Long distance running requires a degree of mental endurance together with the physical requirements. Stepping up your mileage would also contribute to weight control/loss.

1 your running which is cool, second your 9 minute mileing which is very very cool. Food wise try putting things like chilli flakes and black pepper in every thing it fires up the metabolism, have a look on the net for spices that help to increase metabolism burn rate.

Have 6/8 small meals a day, count calories divide your calories between the small meals, as far as possible go for low/ medium GI glycemic index foods as they leave you feeling fuller for longer.

Drink freezing cold water from the fridge it burns calories for your body to warm it up

Chew gum again burns calories

This is going to sound wierd but become a fidget, movement any movement is burned calories.

I was amazed at how really seemingly small things build up to substantial weight loss.

Martenkay -with regards to mileage I'm increasing my long run by two miles per week and I have 19 weeks to go before the marathon. My depression has been a thorn in my side for about 8 years but I will beat the b*stard! by means of CBT as well as my medication. The running for me is literally a lifesaver because it's the only means that I can de stress. (My wife now knows that if she wants a job done then it is best to ask me after a run!)

Gareth -thanks for the advice about cold water and chilli flakes -I'll give it a go and start counting calories. I've already knocked indian takeways and alcohol on the head (Don't miss the beer but crave for a madras!) Hopefully my weight will decrease as my mileage increases!

Other than the increased appetite, how are you getting on with your medicaiton? Are they working for you? Lots of doctors are reluctant to change from a regimen that's working - increased appetite associated with olanzapine is well-documented, but it is a very effective medication.

What was your weight like pre-medication? Have you only gained since starting the olanzapine, or did you have a few excess pounds beforehand?

As far as I know there is nothing within the medication that will itself cause weight-gain. So if you can control your intake despite the increased appetite, then there's no reason you can't lose weight, or at least prevent further gain.

One of the most important tools I've found when working with people who want to lose weight it to ask them to keep a food diary - knowing what you're eating and what your behaviours are around food is so incredibly important in weight loss. If you don't have a good grip on what you're doing, how can you expect to know what to change? If you can, keep a food diary (everything - food and drink) for a few days. A week if possible. Then have a good look at it and see what you can change. It may be portion sizes, food choices, snacking, boredom eating, night time eating - any of these things and more. Once you can recognise some 'problem' areas, then you can work out a plan to overcome them. Put some details up on here if you like and I'll have a look

The medication does seem to work as I usually get a good nights sleep without waking up in the early hours like I did beforehand. Since taking on the medication my appetite/weight has increased -my CBT Therapist told me that it is one of the known side effects of olanzipine to put on weight. My doctor confirmed this and told me that it is better to be overweight than in a bad state of depression which is suppose is true as my "bad" days have virtually gone since taking it. He is also aware of me running and the importance of it as a stress reliever (I survived xmas!). I have put on two stone in weight since starting the medication and am permanently hungry. I try to eat good stuff like fruit and veg, pasta etc., only use sweeteners with coffee and avoid sweeties nuts and chocolate. After a run I tend to eat like a horse!

So in hindsight I will try to keep a diary (new years resolution) and see how it goes. Sarah I may well send you a food diary...I have tried sticking to salads before but tend to get rather bored of them. I do love my pasta usually with a very thin sauce. I'm not a dairy fan except for mullerlight yogurts. I will also give Quorn a try.

Happy new year to you all and I sincerely hope or better still intend to give a positive report in the very near future!

+1 on a food diary. You will see patterns more readily that you can act on.

I kept a diary for couple weeks some years ago. I drink milky tea and coffee, and was surprised at how much milk and therefore on many calories I take in that way.

Pasta and bread are what I need to keep a lid on weight-wise. It may not mean completly cutting out but for instance buying wholemeal rather than regular pasta. There is then a visual reminder with the colour not to cook a whole heap of past, but just enough. I might buy a different brand bread - again so that when I'm taking out a slice there is the reminder not to toast half a loaf, just one slice.

Glad to hea your happy with your medication- it can take years to get that right and is more often then not a trial and error experience so if it works I would say don't stop it!

I would though add that as much as the pills can and do affect weight, what you eat matters far more then how much you exercise. I'd strongly back up the advice on keping a food diary and also seeing a dietition. What you eat matters alot and its well known that the pills you take can make you feel hungrier then normal and even to feel hungry when your body doesn't even need food. Learning your real appetite from one which is created by an inbalance in chemicals.

Filling up on lower calorie foods can help a lot. Things like steamed green vegetables, less sweeter fruits berrys, apples, pears etc rather then tropical fruits such as mango or lychees or sharon fruits or figs) and rather then filling up on white carbohydrates such as bread or rice and pasta. Eating protein can also help a lot in terms of feeling fuller for longer. Protein can be found in foods such as meat, fish, tofu/soya and dairy but try to choose the lower fat versions which offer more nutrition for fewer calories.

At the end of the day its the calories you eat that decide if you gain weight rather then the volume but if I could give one peice of advice yo you it would be to try to get used to eating smaller portions of everything. This means your stomach gradually gets used to smaller meals and you find your less hungry all the time. It can take a while for this to settle but it does make a difference. However, getting a balanced nutritional diet is also very important so I'd suggest also speaking to a dietition in addition to everything else your doing.

I try to eat good stuff like fruit and veg, pasta etc., only use sweeteners with coffee and avoid sweeties nuts and chocolate. After a run I tend to eat like a horse!

So in hindsight I will try to keep a diary (new years resolution) and see how it goes. Sarah I may well send you a food diary...I have tried sticking to salads before but tend to get rather bored of them. I do love my pasta usually with a very thin sauce. I'm not a dairy fan except for mullerlight yogurts. I will also give Quorn a try.

Happy new year to you all and I sincerely hope or better still intend to give a positive report in the very near future!

A few things here.

Firstly, after a run do you feel especially hungry? Lots of people make the mistake of 'rewarding' a run with lots of food, when in reality the calorie burn isn't that great. It's easy to overcompensate and eat more than you need to.

Secondly, wanting to lose weight doesn't mean you have to eat nothing but salad! If you restrict your diet in such a way it's no surprise that you'd get bored and slip back to old habits. You need to make changes that are sustainable and, preferably, enjoyable. That way you won't be left wanting.

If appetite is a problem, which sounds the case, then you need to find a way of satisfying it and/or overcoming the desire to eat. Things like chewing sugar free gum simulates the action of eating without the intake of calories and can suppress appetite. And the minty fresh taste of gum often makes other food less appetising - the same goes for brushing your teeth. Or have sugar-free mints or other hard sweets - they give your mouth something to do other than eat. Drinking water is a great idea - satiety (feeling satisfied after eating) is partly triggered when receptors in the stomach recognise fullness. Drinking a large glass of water, or any low calorie drink, takes up some of the stomach capacity and so you're far more likely to consume less food when you eat. So drink regularly, especially 10-20 minutes before the start of a meal.

Good luck with the food diary. It's easier if you can write things down as you eat them rather than relying on memory at the end of the day. Lots of my patients have found it so useful that they keep it up after the initial week and goal setting, just to keep an eye on how things are going. Some have also found it as a motivator in itself - they don't want to have to write down that chocolate bar or extra Yorkshire pudding, so they think twice about eating it!

Thanks for all the useful advice -the chewing gum sounds a good idea as well as drinking lots more water. I will also try a bit more portion control as well.

It would appear from all the good advice I've been given that a visit to my Doctor is in order and hopefully I might get referred to a dietician. I've also spoken to my wife who is going to join me in monitoring food intake as she want to lose a few pounds as well!

The only thing that does concern me is when I am running for say longer than an hour I do use an energy drink or gel to top the tank up. Perhaps it is psychological, but I've dried using water instead and seem to run out of steam alot quicker. I will also need to be careful with sugar free gum as I know an overload of sorbitol is a surefire way to "runners trots"!

I've already started the food diary this evening and will add it to my running log.

It's great that your wife is supportive Bill - it should make a big difference! Sharing meals is so much easier if both people are on board with dietary change

As for the chewing gum, sorbitol can act as a laxative so just watch how much you consume!

Re. the energy drinks and gels. If well nourished, the body has enough glycogen stores for at least 90 minutes of activity, so it could be psychological that you feel you're running out of steam. But if you're used to using them, then it could be a learned behaviour that you feel you need them - your body has got used to having them. For the purposes of long runs, there's no reason not to use them. For the purposes of weight loss, they are an additional energy source so will detract from the deficit you're aiming for each day. You need to balance your training goals with your weight-loss goals. For a marathon you'll benefit from training with energy drinks/gels, as it gives your gut the chance to accommodate them and avoid problems on race day. So there's no reason to say stop using them - just be judicious in when you use them and for what duration/distance of run.

It's great that your wife is supportive Bill - it should make a big difference! Sharing meals is so much easier if both people are on board with dietary change

As for the chewing gum, sorbitol can act as a laxative so just watch how much you consume!

Re. the energy drinks and gels. If well nourished, the body has enough glycogen stores for at least 90 minutes of activity, so it could be psychological that you feel you're running out of steam. But if you're used to using them, then it could be a learned behaviour that you feel you need them - your body has got used to having them. For the purposes of long runs, there's no reason not to use them. For the purposes of weight loss, they are an additional energy source so will detract from the deficit you're aiming for each day. You need to balance your training goals with your weight-loss goals. For a marathon you'll benefit from training with energy drinks/gels, as it gives your gut the chance to accommodate them and avoid problems on race day. So there's no reason to say stop using them - just be judicious in when you use them and for what duration/distance of run.

Very well put (above). If its any help Bill, I tend to do workouts for over an hour at a time regularly, for example I might run for 45 mins then cycle/spin for another 20 then use the cross trainer for 15 then the stairmaster/stepper for 10. I just go on water. When I'm done I do tend to eat within an hour but its normally just enough to tide me over until I get home an hour later, so a boiled egg and an orange then go home and cook and eat dinner. Its been my way of doing things for a few years now and I'm not having any negative nutritional effects on that. I eat because it helps stop me eating everything when I get home and also because I know I need the electrolytes and blood sugar levels restoired. I have never had any electrolyte drinks or sachet foods as I know I can get the same levels of nutrients from real foods and probably less refined foods too!

I would suggest the packeted stuff you get from runners stores but they would mean you eat less normal foods and lets face it, when your trying to lose weight and having to cut down on what you eat, eating even less again because you've 'spent' your calories on quick fixes to replenish after running/exercising, its going to feel that much harder to keep to any cut backs you've had to make.

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